Provider Demographics
NPI:1841584125
Name:GELOSO, MARY ANGELA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANGELA
Last Name:GELOSO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-2319
Mailing Address - Country:US
Mailing Address - Phone:315-895-0252
Mailing Address - Fax:
Practice Address - Street 1:10 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ILION
Practice Address - State:NY
Practice Address - Zip Code:13357-1822
Practice Address - Country:US
Practice Address - Phone:315-894-7283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist